Article Summary

Esophageal Transit of Six Commonly Used Tablets and Capsules

When drugs are taken orally, there is a common assumption that they quickly and directly enter the stomach. However, in certain instances, pills may adhere to the esophageal membrane, leading to irritation as they disintegrate. This study aimed to investigate the impact of the subject’s position and the amount of water consumed with the medication on the esophageal transit time of six commonly used tablets and capsules in 121 healthy volunteers, utilizing fluoroscopy.

The study encompassed a total of 726 swallowing instances, revealing that 22% of them experienced delays of pills in the esophagus. Surprisingly, only one-third of those with delayed pill transit exhibited any symptoms, suggesting that a few patients developed signs of poor pill swallowing. The primary cause of failed pill swallowing was identified as the combination of a small water quantity (25 ml) and the patient being in the recumbent position.

The study underscored the importance of taking medication with at least 100 ml of water to ensure the passage of large tablets through the esophagus, irrespective of the subject’s position. Additionally, it found that in some cases, increased water quantities could not wash capsules down into the stomach, indicating that capsules pose a higher risk of ulceration, perforation, and even stricture compared to tablets.

Elderly subjects experienced longer transit times with large tablets, possibly due to both the size and shape of the tablets and age-related physiological changes. Some elderly patients struggled to swallow 100 ml of water, often limited to just sipping it.

The study’s results yielded essential recommendations for patients: remain standing for at least 90 seconds after taking medication, swallow tablets with at least 100 ml of fluid, and opt for small oval tablets. In cases where large tablets are necessary, an oval shape is preferable to round. Patients who are bedridden or have difficulty swallowing should be administered liquid medication.

References:

Hey H, Jørgensen F, Sørensen K, Hasselbalch H, Wamberg T. Oesophageal transit of six commonly used tablets and capsules. Br Med J (Clin Res Ed). 1982;285(6356):1717-1719. doi:10.1136/bmj.285.6356.1717

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